NURSE PRACTITIONERS IN PRIMARY CARE
EXAM 4 ACTUAL TEST SCRIPT 2026
COMPLETE QUESTIONS AND ANSWERS
GRADED A+
◉ Stages of heart failure. Answer: stage A- cardiac structure
abnormalities but no symptoms. goal: reduce risk
stage B-increased filling pressures, persistently elevated troponin
without dx or increased BNP
stage C-Structural heart disease with current or previous symptoms
of HF.
stage D- Marked HF symptoms that interfere with daily life and with
recurrent hospitalizations despite attempts to optimize GDMT.
◉ most common causes of HF. Answer: ischemic heart disease and
myocardial infarction (MI), hypertension, and valvular heart disease
(VHD
◉ approach to HF. Answer: clinicians should seek the cause of HF
because appropriate treatment may be determined by the cause
,◉ assessing clinical s/s of congestion in HF. Answer: presence of
jugular venous distention, orthopnea, bendopnea, a square-wave
response to the Valsalva maneuver, and leg edema
◉ lab studies for heart failure. Answer: complete blood count,
urinalysis, serum electrolytes (including sodium, potassium,
calcium, and magnesium), blood urea nitrogen, serum creatinine,
glucose, fasting lipid profile, liver function tests, iron studies (serum
iron, ferritin, transferrin saturation), and thyroid-stimulating
hormone level and electrocardiography
◉ imaging recommendations for HF. Answer: comprehensive TTE is
the most useful initial diagnostic test given the vast amount of
diagnostic and prognostic information provided. The determination
of LVEF is a fundamental step to classify HF and to guide evidence-
based pharmacological and device-based therapy
◉ exercise tolerance testing in HF. Answer: CPET and the 6-minute
walk test are standardized, reliable, and reproducible tests to
quantify functional capacity.19-22 The NYHA functional
classification can be used to grade the severity of functional
limitation based on patient report of symptoms experienced with
activity1 and is used to define candidates for certain treatments.
◉ Stage A heart failure management. Answer: patients who are at
high risk for developing heart failure but have no structural
abnormalities
, BP <130/80
diet
exercise
weight loss
stop smoking
If diabetics SGLT2 (flozin) or GLP-1 (tide)
◉ Stage B heart failure management. Answer: pre-HF (increased
filling pressures, persistently elevated troponin without dx or
increased BNP)
Start ACEI or ARB if LVEF <40
BB if LVEF <40 and hx CAD or MI (some also say just start these
anyway)
ICD if LVEF <30
Statin if indicated
NO CCBs OR TZDs !!!!
◉ Stage C and D management. Answer: ACE/ARB
EXAM 4 ACTUAL TEST SCRIPT 2026
COMPLETE QUESTIONS AND ANSWERS
GRADED A+
◉ Stages of heart failure. Answer: stage A- cardiac structure
abnormalities but no symptoms. goal: reduce risk
stage B-increased filling pressures, persistently elevated troponin
without dx or increased BNP
stage C-Structural heart disease with current or previous symptoms
of HF.
stage D- Marked HF symptoms that interfere with daily life and with
recurrent hospitalizations despite attempts to optimize GDMT.
◉ most common causes of HF. Answer: ischemic heart disease and
myocardial infarction (MI), hypertension, and valvular heart disease
(VHD
◉ approach to HF. Answer: clinicians should seek the cause of HF
because appropriate treatment may be determined by the cause
,◉ assessing clinical s/s of congestion in HF. Answer: presence of
jugular venous distention, orthopnea, bendopnea, a square-wave
response to the Valsalva maneuver, and leg edema
◉ lab studies for heart failure. Answer: complete blood count,
urinalysis, serum electrolytes (including sodium, potassium,
calcium, and magnesium), blood urea nitrogen, serum creatinine,
glucose, fasting lipid profile, liver function tests, iron studies (serum
iron, ferritin, transferrin saturation), and thyroid-stimulating
hormone level and electrocardiography
◉ imaging recommendations for HF. Answer: comprehensive TTE is
the most useful initial diagnostic test given the vast amount of
diagnostic and prognostic information provided. The determination
of LVEF is a fundamental step to classify HF and to guide evidence-
based pharmacological and device-based therapy
◉ exercise tolerance testing in HF. Answer: CPET and the 6-minute
walk test are standardized, reliable, and reproducible tests to
quantify functional capacity.19-22 The NYHA functional
classification can be used to grade the severity of functional
limitation based on patient report of symptoms experienced with
activity1 and is used to define candidates for certain treatments.
◉ Stage A heart failure management. Answer: patients who are at
high risk for developing heart failure but have no structural
abnormalities
, BP <130/80
diet
exercise
weight loss
stop smoking
If diabetics SGLT2 (flozin) or GLP-1 (tide)
◉ Stage B heart failure management. Answer: pre-HF (increased
filling pressures, persistently elevated troponin without dx or
increased BNP)
Start ACEI or ARB if LVEF <40
BB if LVEF <40 and hx CAD or MI (some also say just start these
anyway)
ICD if LVEF <30
Statin if indicated
NO CCBs OR TZDs !!!!
◉ Stage C and D management. Answer: ACE/ARB
